Healthcare Provider Details

I. General information

NPI: 1821311077
Provider Name (Legal Business Name): MATTHEW ANTHONY ZAVALA BA PSY, MA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 TAYLORVILLE RD STE 204
GRASS VALLEY CA
95949-9632
US

IV. Provider business mailing address

908 TAYLORVILLE RD STE 205
GRASS VALLEY CA
95949-9632
US

V. Phone/Fax

Practice location:
  • Phone: 530-771-6845
  • Fax:
Mailing address:
  • Phone: 530-334-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: